California faces a shortage of registered nurses and needs to increase the supply to keep pace with the rapid growth of the state's population, according to a study by researchers at the University of California, San Francisco and the Public Policy Institute of California.

Based on California's projected population growth, researchers from the UCSF Center for California Health Workforce Studies estimate an additional 43,000 registered nurses (RNs) will be needed by 2010 and an additional 74,000 by 2020 to maintain a stable ratio of RNs to population.

"These projections may understate future demand for RNs, if California's new RN staffing legislation requires hospitals to increase the number of RNs they employ," said Janet Coffman, MPP, lead author and associate director of the UCSF Center for California Health Workforce Studies, part of the UCSF Center for the Health Professions. "Under this legislation the California Department of Health Services must issue regulations that stipulate minimum RN staffing ratios for hospitals."

The study, published in the December issue of Image: Journal of Nursing Scholarship, was funded by Health Resources and Services Administration's (HRSA) Bureau of Health Professions, part of the US Department of Health and Human Services.

"Since California is often a bellwether for emerging trends across the United States, this study has significant implications for the future of nursing and patient care," said HRSA administrator Claude Earl Fox, MD, MPH. "Increasingly, nurses are taking on added responsibilities in providing direct patient care, and we must ensure there are enough registered nurses to meet coming demands."

Approximately 230,000 RNs lived in and were licensed to practice in California in 1996; 77 percent of California RNs were employed in nursing. A majority of RN students in California (84 percent ) received their basic nursing education at public institutions, mainly at community colleges and the California State University system, according to the study. Large numbers of qualified applicants, said Coffman, are currently turned away from basic RN education programs because of lack of resources such as inadequate budgets to hire faculty and to increase enrollment.

Coffman and co-author Joanne Spetz, PhD, assistant professor at the UCSF School of Nursing and research fellow at the Public Policy Institute of California based their estimate of future demand for RNs on projections from California's Department of Finance that the state's population will increase 23 percent between 1998 and 2010 and 40 percent between 1998 and 2020. They estimated the future shortage of RNs by combining an analysis of HRSA's 1996 National Sample survey of Registered Nurses with projections from the Department of Finance. The additional nurses estimated to be needed would be to maintain the state's 1996 ratio of 566 employed registered nurses per 100,000 California residents.

The researchers note that employers need to address the fact that RN wages did not keep pace with inflation during the mid-1990's. In addition, they recommend that employers strive to improve working conditions to recruit and retain more RNs. However, they conclude that employers will need assistance from policymakers.

"Demand for RNs will rise rapidly over the next two decades as the population in California grows. Improvements in wages and working conditions might lead to modest increases in the number of California RNs working in the field and in migration from other states and countries but will not be adequate to meet the state's long range requirements," said Coffman.

To increase the supply of registered nurses in California, Coffman and Spetz recommend:

• An increase in the number of RNs educated in public colleges and universities by expanding RN programs at California State University (CSU) and the community college system.
• Increased state funding for basic RN education in the CSU and community college system.

The researchers also recommend increased efforts to improve the ethnic diversity of California's workforce because California's population will become even more racially/ethnically diverse in the future.

"We support a number of programs aimed at increasing the supply of registered nurses in states across the country," said Vincent C. Rogers, DDS, MPH, HRSA associate administrator for health professions. "We will work with California agencies to find ways to address this potential shortage."

The UCSF Center for California Health Workforce Studies analyzes the distribution, diversity, supply and competence of health professionals in California and the impact of federal and state policies on these concerns.

Health Resources and Services Administration is the lead Health and Human Services Agency for improving access to health care for individuals and families nationwide.